How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

Tactical ethics: how the discourses of fairtrade and black economic empowerment change and interact in wine networks from South Africa to the UK.

This paper explores the spaces and power relations of ethical foodscapes. Ethics can offer a commodity a valuable unique selling point in a competitive marketplace but managing the changeable and multiple motivations for stakeholder participation throughout the commodity chain in order to utilise this opportunity is a complex negotiation. Through exploring the spaces and relations within three South African– UK ethical wine networks, the discursive tactics used to sustain these are uncovered. The discourses of Fairtrade, Black Economic Empowerment and organics are highly adaptive, interacting with each other in such a way as to always be contextually appealing. This ‘tactical mutability’ is combined with ‘scales of knowing’, which, this paper argues, are essential for network durability. ‘Scales of knowing’ refers to the recognition by stakeholders of the potential for different articulations of a discourse within the network, which combines with ‘tactical mutability’ to allow for a scalar, contextual and ’knowing’ (im)mutability to ensure the discourse’s continued appeal. However, even when one discourse is the ‘lead’ it always folds within it linkages to other ethical discourses at work, suggesting that ethical practice is mutually supportive discursively. This means that at the producer end ethical interactions may offer more capacity to enact genuine transformation than the solo operations of a discourse.

Privatisation, empowerment and accountability: What are the policy implications for establishing effective farmer organisations?

Weak institutional development and information flows have constrained the extent to which the small-holder farming sector in developing countries can significantly drive growth and poverty reduction. Thisis despite widely implemented economic liberalisation policies focussing on market efficiency. Farmerorganisations are viewed as a potential means of addressing public and private institutional failure but thishas frequently been limited by inequalities in access to power and information. This article investigatestwo issues that have received little research attention to date: what role downward accountability plays inenabling farmer organisations to improve services and markets, and what influences the extent to whichdownward accountability is achieved. Kenya Tea Development Agency (KTDA), one of the largest farmerorganisations in the world (>400,000 farmers) is examined alongside wider literature. Mixed methodswere used including key informant interviews, and eight months of participant observation followedby a questionnaire survey. The article concludes that without effective downward accountability farmerorganisations can become characterised by institutions and mechanisms that favour elites, restrictedweak coordination and regulation, and manipulated information flows. This in turn reduces individuals’incentives to invest. If farmer organisations are to realise their potential as a means of enabling the small-holder sector to significantly contribute to economic growth and poverty reduction, policy and researchneeds to address key factors which influence accountability including: how to ensure initial processes information of farmer organisations establish appropriate structures and rules; strong state regulation toenhance corporate accountability; transparent information provision regarding actions of farmer organi-sation leaders; and the role independent non-government organisations can play. Consequently attentionneeds to focus on developing means of legitimising rights, building poor people’s capacity to challengeexclusion, and moving from rights to obligations regarding information provision.

Are we there yet? Exploring empowerment at the microscale in the South African wine industry

Empowerment is a standard but ambiguous element of development rhetoric and so, through the socially complex and contested terrain of South Africa, this paper explores its potential to contribute to inclusive development. Investigating micro-level engagements with the national strategy of Broad-Based Black Economic Empowerment (B-BBEE) in the South African wine industry highlights the limitations, but also potential, of this single domain approach. However, latent paternalism, entrenched interests and a ‘dislocated blackness’ maintain a complex racial politics that shapes both power relations and the opportunities for transformation within the industry. Nonetheless, while B-BBEE may not, in reality, be broad-based its manifestations are contributing to challenging racist structures and normalising changing attitudes. This paper concludes that, to be transformative, empowerment needs to be re-embedded within South Africa as a multi-scalar, multi-dimensional dialogue and, despite the continuation of structural constraints, positions the local as a critical scale at which to initiate broader social change.

Sustainable development, rolled-out neoliberalism and sustainable communities

Recent contributions by geographers on the relationships between states and citizens have documented the rise of rolled-out neoliberalism. Development agendas are, it is argued, increasingly dominated by the principles of market-driven reforms, social inequality, and a drive towards enhancing the economic competitiveness of the supply side of the economy. However, at the same time, a parallel set of discourses has emerged in the development literature which argues that it is principles of sustainable development that have, in practice, become dominant. The emphasis is, instead, on democratic empowerment, environmental conservation, and social justice. This paper examines the relationships between these ostensibly very different interpretations of contemporary development with an assessment of one of the Labour government's most ambitious planning agendas-the publication in February 2003 of the document Sustainable Communities: Building for the Future. The proposals are promoted as a "step change" in the planning system with a new emphasis on tackling shortages of housing in the South East and reviving the economy of the Thames Gateway area. The paper assesses the different ways in which such programmes can be interpreted and argues that contemporary development practices in countries such as Britain are constituted by a hybridity of approaches and rationalities and cannot be reduced to simple characterisations of rolled-out neoliberalism or sustainable development.

Television and the popular: viewing from the British perspective

The academic discipline of television studies has been constituted by the claim that television is worth studying because it is popular. Yet this claim has also entailed a need to defend the subject against the triviality that is associated with the television medium because of its very popularity. This article analyses the many attempts in the later twentieth and twenty-first centuries to constitute critical discourses about television as a popular medium. It focuses on how the theoretical currents of Television Studies emerged and changed in the UK, where a disciplinary identity for the subject was founded by borrowing from related disciplines, yet argued for the specificity of the medium as an object of criticism. Eschewing technological determinism, moral pathologization and sterile debates about television's supposed effects, UK writers such as Raymond Williams addressed television as an aspect of culture. Television theory in Britain has been part of, and also separate from, the disciplinary fields of media theory, literary theory and film theory. It has focused its attention on institutions, audio-visual texts, genres, authors and viewers according to the ways that research problems and theoretical inadequacies have emerged over time. But a consistent feature has been the problem of moving from a descriptive discourse to an analytical and evaluative one, and from studies of specific texts, moments and locations of television to larger theories. By discussing some historically significant critical work about television, the article considers how academic work has constructed relationships between the different kinds of objects of study. The article argues that a fundamental tension between descriptive and politically activist discourses has confused academic writing about ›the popular‹. Television study in Britain arose not to supply graduate professionals to the television industry, nor to perfect the instrumental techniques of allied sectors such as advertising and marketing, but to analyse and critique the medium's aesthetic forms and to evaluate its role in culture. Since television cannot be made by ›the people‹, the empowerment that discourses of television theory and analysis aimed for was focused on disseminating the tools for critique. Recent developments in factual entertainment television (in Britain and elsewhere) have greatly increased the visibility of ›the people‹ in programmes, notably in docusoaps, game shows and other participative formats. This has led to renewed debates about whether such ›popular‹ programmes appropriately represent ›the people‹ and how factual entertainment that is often despised relates to genres hitherto considered to be of high quality, such as scripted drama and socially-engaged documentary television. A further aspect of this problem of evaluation is how television globalisation has been addressed, and the example that the issue has crystallised around most is the reality TV contest Big Brother. Television theory has been largely based on studying the texts, institutions and audiences of television in the Anglophone world, and thus in specific geographical contexts. The transnational contexts of popular television have been addressed as spaces of contestation, for example between Americanisation and national or regional identities. Commentators have been ambivalent about whether the discipline's role is to celebrate or critique television, and whether to do so within a national, regional or global context. In the discourses of the television industry, ›popular television‹ is a quantitative and comparative measure, and because of the overlap between the programming with the largest audiences and the scheduling of established programme types at the times of day when the largest audiences are available, it has a strong relationship with genre. The measurement of audiences and the design of schedules are carried out in predominantly national contexts, but the article refers to programmes like Big Brother that have been broadcast transnationally, and programmes that have been extensively exported, to consider in what ways they too might be called popular. Strands of work in television studies have at different times attempted to diagnose what is at stake in the most popular programme types, such as reality TV, situation comedy and drama series. This has centred on questions of how aesthetic quality might be discriminated in television programmes, and how quality relates to popularity. The interaction of the designations ›popular‹ and ›quality‹ is exemplified in the ways that critical discourse has addressed US drama series that have been widely exported around the world, and the article shows how the two critical terms are both distinct and interrelated. In this context and in the article as a whole, the aim is not to arrive at a definitive meaning for ›the popular‹ inasmuch as it designates programmes or indeed the medium of television itself. Instead the aim is to show how, in historically and geographically contingent ways, these terms and ideas have been dynamically adopted and contested in order to address a multiple and changing object of analysis.

Adapting to new challenges: extension theory and practice for the 21st century

Twenty first century challenges facing agriculture include climate change, threats to food security for a growing population and downward economic pressures on rural livelihoods. Addressing these challenges will require innovation in extension theory, policy and education, at a time when the dominance of the state in the provision of knowledge and information services to farmers and rural entrepreneurs continues to decline. This paper suggests that extension theory is catching up with and helping us to understand innovative extension practice, and therefore provides a platform for improving rural development policies and strategies. Innovation is now less likely to be spoken of as something to be passed on to farmers, than as a continuing process of creativity and adaptation that can be nurtured and sustained. Innovation systems and innovation platforms are concepts that recognise the multiple factors that lead to farmers’ developing, adapting and applying new ideas and the importance of linking all actors in the value chain to ensure producers can access appropriate information and advice for decision making at all stages in the production process. Concepts of social learning, group development and solidarity, social capital, collective action and empowerment all help to explain and therefore to apply more effectively group extension approaches in building confidence and sustaining innovation. A challenge facing educators is to ensure the curricula for aspiring extension professionals in our higher education institutions are regularly reviewed and keep up with current and future developments in theory, policy and practice.

Return of the 'Angry Woman': authenticating female physical action in contemporary cinema

In 1999, Elizabeth Hills pointed up the challenges that physically active women on film still posed, in cultural terms, and in relation to certain branches of feminist theory . Since then, a remarkable number of emphatically active female heroes have appeared on screen, from 'Charlie’s Angels' to 'Resident Evil', 'Aeon Flux', and the 'Matrix' and 'X-Men' trilogies. Nevertheless, in a contemporary Western culture frequently characterised as postfeminist, these seem to be the ‘acceptable face’ – and body – of female empowerment: predominantly white, heterosexual, often scantily clad, with the traditional hero’s toughness and resolve re-imagined in terms of gender-biased notions of decorum: grace and dignity alongside perfect hair and make-up, and a body that does not display unsightly markers of physical exertion. The homogeneity of these representations is worth investigating in relation to critical claims that valorise such air-brushed, high-kicking 'action babes' for their combination of sexiness and strength, and the feminist and postfeminist discourses that are refracted through such readings. Indeed, this arguably ‘safe’ set of depictions, dovetailing so neatly with certain postfeminist notions of ‘having it all’, suppresses particular kinds of spectacles in relation to the active female body: images of physical stress and extension, biological consequences of violence and dangerous motivations are all absent. I argue that the untidy female exertions refused in popular “action babe” representations are now erupting into view in a number of other contemporaneous movies – 'Kill Bill' Vols 1 & 2, 'Monster', and 'Hard Candy' – that mark the return of that which is repressed in the mainstream vision of female power – that is, a more viscerally realistic physicality, rage and aggression. As such, these films engage directly with the issue of how to represent violent female agency. This chapter explores what is at stake at a representational level and in terms of spectatorial processes of identification in the return of this particularly visceral rendering of the female avenger.

The technocratic totalitarianism of construction process improvement: a critical perspective

The current research agenda for construction process improvement is heavily influenced by the rhetoric of business process re-engineering (BPR). In contrast to the wider literature on BPR, there is little evidence of critical thought within the construction management research community. A postmodernist interpretation is advocated whereby the reality of management practice is defined by the dominant management discourse. The persuasiveness of BPR rhetoric is analysed with particular reference to the way in which it plays on the insecurity of modern managers. Despite the lip service given to ‘empowerment’ and ‘teamwork’, the dominant theme of the re-engineering movement is that of technocratic totalitarianism. From a critical perspective, it is suggested that BPR is imposed on construction organizations to ensure continued control by the industry's dominant power groups. Whilst industry leaders are fond of calling for ‘attitudinal and cultural improvement’, the language of the accepted research agenda continually reinforces the industry's dominant culture of ‘control and command’. Therefore, current research directions in process improvement perpetuate existing attitudes rather than facilitating cultural change. The concept of lean construction is seen to be the latest manifestation of this phenomenon.

Smoking and symbolism: children, communication and cigarettes

Health promotion, with its concern with empowerment and autonomy, must recognize the agency of its target population. Based on 85 in-depth interviews with 10- to 11-year-old children throughout Northern Ireland, this paper argues that it is necessary to focus on the social relations of children if we are to understand and prevent childhood smoking. Addressing the complex issue of childhood agency, it is argued that regardless of various restrictions to their choices, children can act intentionally in constructing their identities. Instead of viewing the smoking children as communicating with the adult world, we focus on smoking as negotiation of status within the children's culture. Such negotiations utilize symbolism derived from and shared with the `adult world'. It is important that those analyzing children's lives understand children's ideas and behaviour on their own terms. We must make sure that the very concepts in which the children's experiences are put are appropriate ones. It is suggested that the metaphor `rite of passage' and terminology such as peer `pressure' versus adult `influence', commonly used to analyse the children's smoking behaviour, may actually conceal important aspects of childhood agency.

Community based ecotourism as a panacea for protected areas: the use of common property theory in its analysis and development

Tourism is the worlds largest employer, accounting for 10% of jobs worldwide (WTO, 1999). There are over 30,000 protected areas around the world, covering about 10% of the land surface(IUCN, 2002). Protected area management is moving towards a more integrated form of management, which recognises the social and economic needs of the worlds finest areas and seeks to provide long term income streams and support social cohesion through active but sustainable use of resources. Ecotourism - 'responsible travel to natural areas that conserves the environment and improves the well- being of local people' (The Ecotourism Society, 1991) - is often cited as a panacea for incorporating the principles of sustainable development in protected area management. However, few examples exist worldwide to substantiate this claim. In reality, ecotourism struggles to provide social and economic empowerment locally and fails to secure proper protection of the local and global environment. Current analysis of ecotourism provides a useful checklist of interconnected principles for more successful initiatives, but no overall framework of analysis or theory. This paper argues that applying common property theory to the application of ecotourism can help to establish more rigorous, multi-layered analysis that identifies the institutional demands of community based ecotourism (CBE). The paper draws on existing literature on ecotourism and several new case studies from developed and developing countries around the world. It focuses on the governance of CBE initiatives, particularly the interaction between local stakeholders and government and the role that third party non-governmental organisations can play in brokering appropriate institutional arrangements. The paper concludes by offering future research directions."